Ear Disease and Surgery Flashcards
What factors can predispose to ear disease?
Abnormal ear conformation Obstruction Excessive moisture Cornification disorders Immunosuppression
What can cause primary inflammation of the ear canal?
FBs Parasites Skin hypersensitivity Contact dermatitis Immune-mediated Miscellaneous
What can cause secondary pathology to abnormal ears?
Staph intermedius Pseudomonas Proteus Klebsiella E. coli Malassezia
What factors can prevent resolution of otitis?
Ear canal pathology
Middle ear disease
What are the two manifestations of otitis?
Chronic pruritic otitis externa
Chronic progressive purulent otitis
How do chronic pruritic otitis externa and chronic progressive purulent otitis differ?
CPOE - Allergic skin disease, secondary infections, bilateral, all of canal, control of inflam required
CPPO - unresolved infection, multifactorial, soft tissue changes, otitis media
What is otitis externa commonly associated with?
Otitis media
Is the tympanum normally intact or broken in otitis media?
Intact
What occurs when otitis progresses from an acute to chronic infection?
Microbial shift of G+ve and Malassezia to G-ve
When is ear surgery indicated?
Tumours, polyps
Irreversible stenosis
Medical treatment has failed
Need for full investigation
How is otitis managed medically?
Cleaning of the ear canal
Topical treatments of infections
Investigation of any underlying disease
Remove predisposing factors
What do topical medicines for otitis contain?
Antifungal
Antibacterial
Glucocorticoid
What are common causes of treatment failure of otitis?
Not long enough
Inadequate ear cleaning
Failure to identify otitis media and soft tissue changes
Failure to identify primary cause
How is response to treatment of otitis monitored?
Cytology of ear swabs
What are the possible adverse effect of otic medication?
AD
Nerve damage
Ototoxicity
Taking cost, length of treatment and effectiveness against Malassezia, which are the ear cleaners of choice?
Osurnia
Surolan
Why are Aurizon and Posatex unsuitable ear cleaners?
They both contain reserve ABs
Why are Auroto and Canaural not always the ideal ear cleaners?
Have no action against Malassezia
What agents may be used alongside water/saling when flushing the ear canal?
0.05% chlorhexidine
0.5% povidone-iodine
Acetic acid 5%
What does the middle ear consist of?
Tympanum Malleus, incus, stapes Eustachian tube Air filled, resp epithelium Para (facial)/symp nerves
What does the inner ear consist of?
Cochlea
Vestibulum
Outline the pathogenesis of othaemtoma…
Otitis/allergy/FB/parasites => scratch and head shaking => fracture of auricular cartilage => fibrin deposition => contraction
What are the clinical signs of othaematoma?
Otitis externa
Thickening of concave side
How is othaematoma treated medically?
Aspiration, drainage
Pressure bandage
How is othaematoma treated surgically?
- S-shaped incision on concave side of pinna
- Remove clots and fibrin
- Flush
- Close cavity with Monocryl
- Protective bandage, collar, AB, analgesia
What direction are sutures place in when closing a othaematoma wound?
Parallel to incision
What are the possible complications of othaematoma removal?
Recurrence
Cartilage degeneration and ossification
Abcessation
What are the indications for a pinnectomy?
Solar injury Neoplasia Trauma Vasculitis Frostbite Recurrent chondritis in cats Permanent marking
What diagnostic tolls are used in assessing the ear canal and middle ear?
Hx and PE
Otoscope
Imaging
What should be assessed on PE for ear canal/middle ear disease?
Posture and gait Position of head Facial nerve paralysis Horner's syndrome Skin problems Discolouration of paws
How should otitis externa be treated before surgery?
Always manage medically
What are surgical options for treating ear problems?
Lateral wall resection
Vertical ear canal ablation
TECA +/- lateral bulla osteotomy
What are the indications for a lateral wall resection of the ear?
Local benign tumour
Malignant tumour in skin
V early otitis externa
What are the indications for a vertical ear canal ablation?
Tumour of the vertical ear
Following separation of vertical and horizontal parts of ear canal
What are the indications for a TECA with lateral bulla osteotomy?
Endstage otitis externa Persistent otitis externa Otitis media Para-aural abscessation Ear canal neoplasia Severe ear canal trauma
What are the possible complications with a TECA and lateral bulla osteotomy?
Deafness Facial nerve paralysis Vestibular diease Haemorrhage Wound infection Wound breakdown Fistulation
What is the most common complication of TECALBO in cats?
Damage to the facial nerve
How can otitis media be treated?
Medical - myringotomy and AB
Surgery
How is otitis media/interna diagnoised?
Otoscopy - red tympanum
Radiography
CT/MRI
How can otitis media/interna be treated durgically in cats?
Ventral bulla osteotomy
